Medicare Part B 2012 Important Changes: What They Mean to Your Practice

On Nov. 1, 2011, the Centers for Medicare & Medicaid Services (CMS) updated payment policies and Medicare payment rates for physicians’ services furnished in 2012.

Highlights of major changes in the fee schedule that impact payment policy and physician billing include:

E-prescribing
CMS finalized the rules for the 2012 and 2013 e-prescribing incentive payment, and the 2013 and 2014 payment penalty programs.

E-prescribing incentive payments will continue for 2012 and 2013.  To qualify for an incentive payment, physicians:
1.    May use claims, registry or electronic health record (EHR)-based reporting methods.
2.    Must electronically prescribe on the same day as the denominator service, and submit 25 claims containing the e-prescribing measure code (G8553) with one of the denominator codes (90801-90802, 90804-90809, 90862, 92002, 92004, 92012, 92014, 96150-96152,99201-99205, 99211-99215, 99304-99310,99315-99316, 99324-99328, 99334-99337,99341-99345, 99347-99350, G0101, G0108, G0109).

The incentive payment for 2012 is 1 percent, and for 2013 it is .5 percent of the total estimated allowed charges for professional services covered by Medicare Part B and furnished by an eligible professional during the reporting period.

There are three methods to avoid the penalty for 2013 and 2014:
1.    Physicians who are successful e-prescribers in 2011 (those who receive the incentive payment) will be exempt from penalty in 2013.  Physicians who are successful e-prescribers in 2012 will be exempt in 2014.
2.    Physician who successfully report the measure code G8553 at least 10 times during the first six months of 2012 (for the 2013 calendar year penalty) and  in the first six month of 2013 (for the 2014 calendar year penalty) will avoid application of the e-prescribing penalty. CMS improved the program to allow physicians to submit the measure code G8553 without linking to qualifying visit (denominator) codes.  The measure code can be used with any fee schedule service during which an electronic prescribing event occurred. The claim must still be submitted to Medicare for payment.
3.    Physicians will be allowed to apply for additional hardship exemptions online, but only from January through June 30 of each calendar year.

Physician Quality Reporting System (PQRS)
As in prior years, there have been changes to the individual measures and measure groups. The final rule:

◦    Finalized 211 individual measures, including 26 new ones
◦    Retained 44 EHR measures currently reportable in the EHR incentive program
◦    Finalized 23 new measure groups, including eight new measures groups for reporting:
    Cardiovascular Prevention
    COPD
    Inflammatory Bowel Disease
    Sleep Apnea
    Dementia
    Parkinson’s
    Elevated Blood Pressure
    Cataracts

Check measures carefully for proper reporting. A complete listing of the 2012 measures will be posted to the CMS website http://www.cms.gov/PQRS// in the near future.

CMS finalized its proposal to provide interim feedback reports for physicians reporting individual measures and measure groups through claims-based reporting for 2012 and beyond. These reports will be a simplified version of annual feedback reports that CMS currently provides and will be based on claims for the first three months of each program year. The interim feedback reports will be provided to physicians during the summer of each program year.

The rule redefined “group practice” under the Group Practice Reporting Option as a group of 25 or more eligible professionals. Organizations wishing to use the GPRO method must again self-nominate.

CMS finalized its proposal to use 2013 as the reporting period for the 2015 PQRS penalty. If CMS determines that a physician or group practice has not satisfactorily reported quality data for the 2013 reporting period, then its 2015 payments will be reduced 1.5 percent. Now is a good time to become familiar with the PQRS reporting system before your payments are negatively affected.

Advanced Imaging Services Multiple Procedure Pricing
CMS has finalized a proposal to apply a 25 percent reduction to the payment for the professional component of second and subsequent advanced imaging services such as CT, MRI, PET, and MRA furnished by the same physician on the same patient in the same session on the same day.

The highest fee schedule service will be allowed at 100 percent of the fee schedule. Subsequent advanced imaging services will be allowed at 50 percent for the technical component, as in the past, and 75 percent for the professional component.

Lab Test Signatures No Longer Required
CMS has retracted the requirement for physicians to sign paper lab requisitions for clinical diagnostic laboratory tests.

 
Annual Wellness Visit (AWV) Changes
CMS has adopted criteria for a health risk assessment (HRA) to be used in conjunction with the AWV.   The HRA is self-reported information which can be done by the patient alone or with assistance, takes no more than 20 minutes to complete and addresses demographic data, psychosocial risks, behavioral risks, activities of daily living (ADL),  and instrumental ADLs.

CMS is increasing the payment for the AWV codes to recognize the additional office staff time required to administer and HRA to the Medicare population.  CMS is also continuing its policy of not covering a routine physical exam as part of these services.

Additional information about coverage and payment changes will be published by CMS over the next few months through MLN Matters articles at http://www.cms.gov/MLNMattersArticles/.

Contact: CMA Reimbursement Help Line at 888-401-5911, or economicservices@cmanet.org